Patient Consent for Telehealth and Compounded Treatment

This document is the patient consent for telehealth services delivered through The Pep Club platform (the “Platform”) and for the treatment of compounded medications dispensed by the Affiliated Pharmacy under prescription from a licensed physician of the Medical Practice. It is the public, printable version of the consent you sign electronically inside the patient portal before your first clinical visit.

By signing the in-portal consent form, you confirm that you have read, understood, and agreed to the terms in this document. If you have not yet signed, you may still read this document; you will be asked to sign in portal before you receive any clinical service or prescription.

This consent is read together with the Terms of Service, the Privacy Policy, and the Refund Policy.

You understand that telehealth is the delivery of healthcare services using electronic communications, information technology, and similar means. Clinical visits with your physician will occur asynchronously (via secure messaging) or synchronously (via secure video or audio), not in person.

Benefits. Telehealth lets you consult with a licensed physician from your home, on your schedule, without the need for an in-person office visit. It often reduces wait times, travel costs, and time away from work.

Limitations and risks. You understand that:

• Information transmitted may not be sufficient for the physician to make an appropriate clinical decision. The physician may, in their sole clinical discretion, decline to proceed by telehealth, request additional laboratory work or examination, or refer you to in-person care;
• Technical failures (audio loss, video freeze, dropped connection, message delay) may interrupt a visit. The physician will reschedule and not bill again for a visit that was prevented by a technical failure;
• Although we protect transmitted information with industry-standard safeguards, electronic communication carries a small residual risk of interception or disclosure outside the parties to the conversation;
• Telehealth visits cannot fully substitute for an in-person physical examination in every clinical situation; and
• Treatment options available by telehealth may be more limited than those available in an in-person setting.

You consent to receive clinical care by telehealth subject to these limitations and risks.

If your physician prescribes a medication through the Platform, the medication will be a compounded preparation prepared by the Affiliated Pharmacy under your individual prescription. The Affiliated Pharmacy is a state-licensed 503A compounding pharmacy operating under Section 503A of the Federal Food, Drug, and Cosmetic Act, United States Pharmacopeia (USP) standards for compounded preparations, and the licensure rules of every state in which it dispenses.

Compounded preparations are customized medications prepared by a licensed compounding pharmacy under U.S.-licensed physician supervision; they are not interchangeable with the brand-name medications they may reference. You understand that compounded preparations are prepared on a per-prescription basis for an individual patient and do not undergo the same pre-market review applied to commercially available finished drug products. Compounded preparations may differ from brand-name alternatives in formulation, concentration, dosage form, route of administration, inactive ingredients, stability, and efficacy and safety profile.

You acknowledge that, as of the date of this consent, the Platform's formulary includes:

• Compounded Semaglutide and compounded Tirzepatide (GLP-1 receptor agonist preparations using the same active ingredients found in brand-name medications, prepared at concentrations or dosage forms specific to your prescription);
• Compounded Glutathione and compounded Nicotinamide Adenine Dinucleotide (NAD+) (compounded antioxidant preparations).

The choice of compounded preparation over a brand-name alternative where one exists is a clinical decision made by your physician based on your individual medical assessment. You may discuss this choice with your physician at any time.

You understand that all medications, including compounded preparations, carry risks. These risks include but are not limited to:

• Side effects (which may be mild, moderate, severe, or, rarely, life-threatening);
• Adverse drug reactions or allergic reactions;
• Drug interactions with other medications, supplements, or substances;
• Contraindications based on existing medical conditions you may not have disclosed or may not be aware of;
• Variability in response from patient to patient; and
• Risks specific to the medication class (for example, GLP-1 receptor agonists carry risks including gastrointestinal effects, gallbladder events, pancreatitis, and rare hypersensitivity reactions).

Your physician will discuss the risks relevant to your prescription with you. You agree to read any medication-information document accompanying your prescription, to ask your physician if you have questions, and to follow dosing and administration instructions carefully.

You agree to:

• Provide truthful, complete, and current information during your medical intake and throughout your care relationship;
• Disclose all medications you are taking, supplements you regularly use, allergies, prior reactions, and relevant medical history;
• Disclose any history that may affect candidacy for the requested treatment, including pregnancy or plans to become pregnant, breastfeeding, recent surgery, or recent hospitalization;
• Take prescribed medications only as directed and only by the person to whom they are prescribed;
• Not share, sell, transfer, or otherwise redistribute prescribed medications;
• Complete required laboratory work and follow-up consultations on schedule (the physician may pause or discontinue therapy if required follow-up is not completed); and
• Report any side effect, adverse event, or change in condition promptly through the patient portal.

You understand that withholding information or providing inaccurate information may result in clinical harm, including death in rare cases.

If you experience any side effect, adverse event, or unexpected change in your condition that you believe may be related to a medication prescribed through the Platform, report it promptly through the in-portal adverse event report (under Patient > Report an event) and notify your physician through the secure messages page. For symptoms suggesting a medical emergency (chest pain, difficulty breathing, severe allergic reaction, suicidal ideation, or any other immediately threatening symptom), call 9-1-1 or go to the nearest emergency department.

The Pep Club and the Medical Practice report serious adverse events to the appropriate regulatory authorities as required by applicable law.

Your consent is voluntary. You may refuse to consent to telehealth or to compounded treatment at any time, and you may withdraw this consent at any time, without affecting your right to seek care elsewhere. To withdraw consent, contact patient support at hello@thepepclub.com or use the in-portal cancellation flow.

Withdrawal of consent stops future clinical service and future prescription refills under the Platform. Withdrawal does not affect the legality of acts already taken under the prior consent (for example, a shipment already dispatched cannot be recalled).

State telehealth rules require the prescribing physician to verify your identity before issuing a prescription. As part of medical intake you will submit a clear photograph of a current government-issued photo identification (driver license, state ID, passport, or military ID) and a selfie photograph for visual match.

A physician of the Medical Practice manually reviews your identification before any prescription is issued. If the photographs are unclear, expired, or do not match, the physician will request a re-submission before proceeding.

If your name, photo, or shipping address materially changes after enrollment, you may be asked to re-verify before a prescription refill or a new prescription is issued. Identity-verification records are part of your medical record and are retained as described in the Privacy Policy.

Several states require additional patient consent for telehealth services or for the prescription of compounded medications. The Pep Club presents state-specific addenda to this consent at the point of intake based on your declared state of residence. Examples of states with additional telehealth-consent requirements include but are not limited to California (Business and Professions Code § 2290.5), Florida (F.S. § 456.47), New Jersey, Ohio, and Texas. Where a state-specific addendum applies to you, you will see it before completing intake and you will be asked to acknowledge it separately.

If state-specific requirements change after you enroll, we may ask you to re-acknowledge an updated consent before the next clinical service or prescription.

Information that you share through the Platform (including biomarker results, medical intake content, consultation messages, video and audio recordings of telehealth visits where applicable, and signed consents) is PHI handled under the Privacy Policy, which serves as the joint HIPAA Notice of Privacy Practices for the Medical Practice. You may request access to, amendment of, or an accounting of disclosures from your medical record at any time per the process described in the Privacy Policy.

You may also request that your records be sent to another physician or institution. The Pep Club will fulfill the request within thirty (30) days, subject to any cost-based fee permitted by HIPAA and applicable state law.

When you complete the in-portal consent form you are asked to type your full legal name, check a box affirming the legal effect of doing so, and submit. The Pep Club records the submission with your IP address, user agent, and a timestamp.

Under the federal Electronic Signatures in Global and National Commerce Act (E-SIGN, 15 U.S.C. §§ 7001 et seq.) and the Uniform Electronic Transactions Act adopted in most states, your typed name plus affirmative checkbox plus submission constitutes a legally binding electronic signature that has the same effect as a handwritten signature. You consent to use of electronic records and electronic signatures for this consent and for related consents and disclosures.

You may cancel your subscription at any time from the patient portal. Cancellation stops future billing and future clinical service. Compounded medications already prepared and shipped are not refundable; see the Refund Policy for the full details.

The Medical Practice may, in its sole clinical discretion, decline to continue care, including for reasons of patient safety, suspected misrepresentation on intake, non-compliance with required follow-up, or relocation to a state where the Medical Practice is not licensed.

By signing the in-portal consent form you confirm that:

• You are at least twenty-one (21) years of age;
• You have read this consent, understand it, and have had the opportunity to ask questions;
• You understand that telehealth is not a complete substitute for in-person care in every clinical situation;
• You understand that compounded preparations are customized medications prepared by a licensed compounding pharmacy and are not interchangeable with brand-name medications they may reference;
• You consent to receive care by telehealth and to receive compounded preparations prescribed for you, subject to the limitations and risks described here;
• You will provide truthful information and follow your physician's instructions;
• You will report adverse events promptly; and
• You may withdraw this consent at any time without affecting your right to seek care elsewhere.

Questions about this consent: legal@thepepclub.com.

Clinical questions: send a message through the patient portal so it can be routed to a physician of the Medical Practice. Do not send clinical questions to a general support email.

Medical emergencies: call 9-1-1 or go to the nearest emergency department.